Frequency of sternal foramen evaluated by MDCT: a minor variation of great relevance

Abstract

Due to inadvertent cardiac or great vessel injury, sternal foramina may pose as a great hazard during sternal puncture. They can also be misinterpreted as osteolytic lesions in cross-sectional imaging of the sternum. The distribution of these variations differs between populations, but data from Brazilians are scarcely reported. Therefore, this study aimed to verify the frequency of midline sternal foramen and double-ended xiphoid process, as developmental variations, in order to avoid fatal complications following sternal puncture of sternal acupuncture treatment. A total of 114 chest computed tomograms were evaluated. The frequency of midline sternal foramen in a complication risk bearing feature is of approximately 10.5%. The double-ended xiphoid process was present in 17.5%. We conclude that sternal acupuncture should be planned in the region of corpus-previous CT should be done to rule out this variation. Furthermore, we strongly recommend the acupuncture technique which prescribes a safe superficial-oblique approach to the sternum.

Morphological approach of the sternal foramen: an anatomic study and a short review of the literature

“…Reported incidence ranges from 0.06% to 18.3%. Prevalence of SF is reported from 0.06% up to 11.6% in radiological studies [4,5,8,18,20,24,26,30], 6.7% to 16.6% in cadaveric studies [3,9,19], and 13.8% and 18.3% in the 2 published anatomic studies, conducted in dry specimens [12,21]. SFs were observed in 5 of 35 sterna (14.6% of dried specimens) in the present study.…”

Evaluation of the morphological characteristic and sex differences of sternum by multi-detector computed tomography

“…Radiologists and pathologists should be aware of the existences of these anatomical variations of the sternum as well as be familiar with their imaging features, in order to avoid diagnosis uncertainties [8,21]. Sternal clefts could be misinterpreted as a traumatic fracture, whereas a Sternal foramen can be mistakenly suggested as an osteolytic lesion [21].…”

“…Sternal clefts could be misinterpreted as a traumatic fracture, whereas a Sternal foramen can be mistakenly suggested as an osteolytic lesion [21]. It may be an isolated malformation or may be accompanied by displacement of the heart or other midline abnormalities [28].…”

“…In living subjects, sternal variations are frequently detected incidentally on cross-sectional images. Radiologists and pathologists should be aware of the existences of these anatomical variations of the sternum as well as be familiar with their imaging features, in order to avoid diagnosis uncertainties [8,21]. [10] studied interindividual variations of the xiphoid process in a wide adult group using 64-row multidetector computed tomography (MDCT).…”

“…It may be an isolated malformation or may be accompanied by displacement of the heart or other midline abnormalities [28]. The awareness of a Sternal foramen is important in acupuncture practice and Sternal marrow aspiration because of the danger of heart damage [8,21]. A Quantitative studies on the Sternal foramen frequency were performed in adult patients through a Roentgenograms [29].…”